HomeMy WebLinkAboutMortgage_Coomer (6)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
7 • FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R71 / 6-09)
, PresviCetl M Departrt�erk of Local Govemmerit Fnamc
INSTRUCTIONS:
To 6e filed in person a by mail wiN the CounryAudito� or Counry Recorde� o/ the counry where the property is ted. �
Fihig Dates: 1) Real Property: M�st file durhg the year /or which Ne deduction is wught
2) Mobde / ManulaUUmd Homes rw[ assessed as Real Property Must file during the Iwelve (12) moriths �f Q
6etae March 37 of each year the deducGOn is saght.
See reversa side lor addilional inshucdons erM quali�cations. � ._„
Ta�dn9 KeY mrnDV / le9al aesaiGtion Remrtf nurtd�er
�.,ea� ab-ia-i9-y��-000. y95-oa7 2��l0
AsxsseC rdlue d real P�P�Y as of A1�a ge / Contraa'udrbtedr�s unpaid as d Mcutgage I ContraG uWeb�s unG� as d Is ihe
MaRh 1. amM year Ma(di t. arterit year data o( appfrcatm kgal
If M� Wh816 hL5 / 11¢f 8i3Gi ShBIB 01111f¢!¢Sl? �
tl narne m remN b dRferent Man that of aPP�• b�d'cate Eelmr.
Name m rtnrtga9ee u mnttact seller i
Addrea W martqagee ar mntract se0er (mmiDei end stree; cdy. smfe. aM LP cada)
Name af assi�ee or dher owner or hdder d mortgage
AEdress of 'gnee (m�m6erend street �: stete. entl LP cnEe)
-r sE � _ a -
ooes e�m,c ow,i wca�v � s�Y ome. rc yes. wt,ac ca,m�/�
munty�lndana?
❑ Yes ❑ No
cour
or���a, avwovea h tlre ama,nt or.
zo_ zo_ 20_ zo.
I I We cert'rfy under U/$penalty of
ovmer I contract �uy�r ot the afor
rrsitlent addres W
Pason auttnRed by OWY e�tetl
�
m
�7 T �
What 7a�d�g D'atrkt?
`z��
OCICf CNlI SPD1152.
Yes L� No
�Pll�l N QIIC�1- /UIIIUB�' �S+65G�
PropeM1Y OMnuallYAssessed
_ I Has ihis EeEtK.tim Eeen re0uesteA m proputy
. o,.....e.+.e..n
� y�'���.�
v`-
D,��„���-.70.. aoio.:.
c���� �to. ...3.`f5�.......
above and foregoing informalion is W e and mrtect arW that tha applirant is a resident of Indiana arM
perty on date apqicaqon is filed. -...
oa�e (r�,m, dar. rea.�
Date (rtxanN. tleY. Y��7
cerson lnurwer anc sfreet �: sb�e, aro z�a ome) . I�
i' j